ASGE Annual GI Advanced Practice Provider Course (On-Demand) - Clinical Case-Based Learning (Day Two) | April 2023-Abnormal Imaging in GI: Tests, Clinical Significance and Impact on Management

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This document discusses common GI imaging studies and their clinical significance in various scenarios. The different imaging studies mentioned include ultrasound, X-ray, CT, MRI, nuclear scans, and procedural tests like ERCP. Several clinical scenarios are highlighted, such as dysphagia, epigastric pain, right lower quadrant pain, jaundice, suspected bile leak, obscure GI bleeding, and liver lesions. For each scenario, specific imaging tests are recommended to aid in diagnosis and management. <br /><br />For dysphagia, video swallow and barium esophagram can help identify conditions like oropharyngeal dysphagia with aspiration, Zenker's diverticulum, and achalasia. Ultrasound and abdominal CT are useful for evaluating epigastric pain and can help diagnose conditions like cholelithiasis, complicated pancreatitis, gastric volvulus, and chronic pancreatitis. Right lower quadrant pain can be assessed with abdominal CT to identify acute appendicitis, intestinal angioedema, and Crohn's ileitis. Jaundice can be evaluated with abdominal ultrasound, CT, MRCP, or ERCP to diagnose intrahepatic/extrahepatic biliary dilation, pancreatic cancer with malignant biliary obstruction, and choledocholithiasis. Suspected bile leak can be confirmed with abdominal CT, HIDA scan, or ERCP. Obscure GI bleeding can be diagnosed with a nuclear bleeding scan or CT angiography. Liver lesions can be evaluated with liver ultrasonography, triple phase liver CT, or contrast-enhanced MRI. <br /><br />Overall, imaging plays a crucial role in diagnosing and managing GI conditions, and it should be used in conjunction with endoscopy when necessary. Diseases of the liver and biliary tree are particularly well-suited for diagnosis using various imaging modalities.

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Aaron Shiels, MD FASGE

Keywords

GI imaging studies

ultrasound

CT

MRI

dysphagia

epigastric pain

jaundice

bile leak

obscure GI bleeding

liver lesions